LIVER DISEASE

Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis

Carol Hutchinson¹, Catherine A Geissler¹, Jonathan J Powell², Adrian Bomford¹

¹ The Iron Metabolism Interdisciplinary Research Group, King’s College London, London, UK
² MRC Human Nutrition Research, Cambridge, UK

Correspondence to:
Dr A Bomford
Institute of Liver Studies, King’s College Hospital, Denmark Hill, London SE5 9RS, UK; adrian.bomford{at}kcl.ac.uk

Background and Aims: During the long-term treatment of patients with hereditary haemochromatosis (HH) the authors observed that proton pump inhibitors (PPI) reduced the requirement for maintenance phlebotomy. Gastric acid plays a crucial role in non-haem iron absorption and the authors performed a case review and intervention study to investigate if PPI-induced suppression of gastric acid would reduce dietary iron absorption in C282Y homozygous patients.

Methods: Phlebotomy requirements to keep serum ferritin 50 µg/l before (mean 6.1 (SE 0.6) years) and during (3.8 (0.9) years) administration of a PPI were evaluated in seven patients and a post-prandial study was performed to determine whether PPIs reduce absorption of non-haem iron (14.5 mg) from a test meal in a further 14 phlebotomised patients with normal iron stores.

Results: There was a significant reduction (p<0.001) in the volume of blood removed annually before (2.5 (0.25) l) and while taking (0.5 (0.25) l) a PPI. Administration of a PPI for 7d suppressed absorption of non-haem iron from the meal as shown by a significant reduction (all p<0.01) in: area under the serum curve (2145 (374) versus 1059 (219)), % recovery of administered iron at peak serum iron (20.5 (3.2) versus 11.0 (2.0)%) and peak serum iron (13.6 (2.4) vs 6.1 (1.2) µmol/l) (all values are before vs during PPI).

Conclusions: Administration of a PPI to patients with HH can inhibit the absorption of non-haem iron from a test meal and the habitual diet.

Abbreviations: AUC, area under the serum iron curve; HCl, hydrochloric acid; HH, hereditary haemochromatosis; H₂RA, H₂-histamine receptor antagonist; NSAIDs, non-steroidal anti-inflammatory drugs; PPI, proton pump inhibitor

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